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I appreciate the "mental ruminating" regarding legal liability. It's pretty obvious that we as a school need to set up something like the care plan you guys mentioned; for this student, as well as any hypothetical future ones with chronic health conditions. It's in the works. But I don't think she'll want to have her family involved. Although I don't know much, what I know is enough to suspect some seriously complicated (and emotionally charged) history there. I will say this: I don't see the student daily (it's three nights a week), and in the two plus years that she's been coming to us, I have witnessed her having a seizure five times, including last week. Only once have I truly been tempted to call an ambulance, and that was this last time, because she had more than one seizure on the same day. I don't feel like "overcharging the 911 system" is really an issue here. The student is pretty good at outlining why she'd rather "the system" stay away, though. I talked to her about it at length two days ago. She pretty much echoes what scubanurse has said. Sarcasm included. Apparently, the usual storyline goes something like this: an ambulance is called. In the best-case scenario, the EMT's are cordial and accommodating, and they ask bystanders if they know which hospital she wants to be taken to, so that when she regains the full extent of her wits, she can talk to someone who's at least read her file. Worst case, they refuse to take her wheelchair with them if it's dirty, or they think they're entitled to treat her roughly because her spasticity makes her post-ictal phase "look weird"; so they decide she's either faking, or has told the people who called the ambulance abject lies about what's really going on with her. Then she gets to the hospital where, roughly half an hour after the seizure that triggered the call, give or take, she can usually answer the first available doctor's questions pretty coherently. Meanwhile, she gets an IV "just in case", for access if she starts seizing again. And maybe, if she runs into a particularly thorough (or particularly skittish) ER doc, a CT will be done. After that, she has to wait anywhere between one and five hours for the bloodwork to come back, which will inevitably tell them that her meds are at a therapeutic level. So they send her on her way with the recommendation "to go see your neurologist ASAP", and maybe a prescription for some Valium derivative "to take in addition to your usual meds until you can see your neurologist". Never mind if it's the middle of the night by the time that happens. Side note: she hates Valium and all of its siblings (or so she says), because it's addictive and "exposure to addictive substances never ends well in my family". Having heard that story, I can no longer fathom why she would want to fake something like this.

So, as I understand the concept, it's not about removing the LSB completely. They still remain in use for intubated patients, combative patients, and those you can't communicate with. The idea, is that conscious, cooperative people will splint their own necks. Further, the application of a traditional LSB/blocks/collar restriction carries some real risks for the patient, with little or no proven benefit. * It takes relatively little time on an LSB to cause pressure ulceration. Most trauma patients are already at increased risk. * Traditional spinal restriction results in a 20% decrease in FRC, which could become a trigger for pre-hospital RSI. * Spinal immobilisation can complicate airway management, and increases ICP. * The LSB is a relatively poor device for spinal "immobiilisation", as you're trying to force a curved structure to conform to a rigid plane. * Healthy volunteers often develop neck pain, and report moderate-to-severe pain when immobilised on an LSB, which can result in unnecessary imaging, which carries costs and risks to the patient. I think the rolls/blocks are primarily there to remind the patient not to move their head. Which is pretty much what they do on an LSB, anyway. I think we're all aware that a patient can generate substantial joint motion while immobilised. There's also the question as to how great the benefit really is with traditional techniques. Only a very small percentage of patients that are immobilised by EMS have c-spine fractures. The vast majority of these are stable fractures. Even most of the radiographicaly "unstable" fractures are not grossly unstable, as in the patient will move their head and displace their c-spine. They're unstable in the sense that it would be unwise to discharge them home, to play soccer or football without addressing the injury. Even when injury does occur in a patient that presents neurologically intact, it's difficult to know whether this is from motion during their care or the natural progression of the initial insult, e.g. cord contusion/concussion. There's a certain argument that the force required to fracture the c-spine is many magnitudes of order greater than any force the patient may apply through voluntary movement of their neck. Also, consider the care provided in the ER, where often the patient is removed from the LSB prior to radiography, and left supine with instruction not to move their head. Even after an injury is identified, it's not like the patient is immediately put back on an LSB and then halo'd. They're basically put on a soft stretcher, and told not to move their head, and log rolled by staff. That's all this really Is. It may be a change in care for EMS, but it's not really a divergence from standard care in the ER. The patients that are combative are still on the LSB --- and these are the patients the ER typically leaves on, right? Because we're using it as a restraint device as much as anything else. The patients that are intubated are still on the LSB -- they can't splint, and tube displacement is a potential disaster. The patients that are significantly altered, or who can't follow instructions due to a cognitive issue or language barrier, they're still on the LSB too. But what's happening, is there's a recognition of the limitations of the LSB, and that "immobilisation", is a fantasy -- what we're doing is restricted motion. This can be accomplished in a number of different ways, which can be tailored to the patient.

No, you have responded to a couple of calls as a citizen who has some knowledge of first aid and have a few friends who are EMTs. You ARE NOT an EMT until you have a card from the state saying you are and approval from your medical director. Thinking anything else is dangerous and will get you and your pts in trouble. You seem eager, which is good, but don't let it end your career before it has even started.